Abstract
BackgroundPosttraumatic stress disorder (PTSD) is common among children and adolescents who have experienced traumatic events. Exposure therapy (ET) has been shown to be effective in treating PTSD in adults. However, it remains uncertain in children and adolescents. AimsTo evaluate the efficacy and acceptability of ET in children and adolescents with PTSD.MethodWe searched PubMed, EMBASE, Cochrane, Web of Science, PsycINFO, CINAHL, ProQuest, LILACS, international trial registries, and others for randomised controlled trials (RCTs) assessed ET in children and adolescents (aged ≤ 18 years) with PTSD up to August 31, 2020. The primary outcomes were efficacy (the endpoint score from PTSD symptom severity rating scales) and acceptability (all-cause discontinuation), secondary outcomes included efficacy at follow-up (score from PTSD scales at the longest point of follow-up), depressive symptoms (end-point score on depressive symptom severity rating scales) and quality of life/social functioning (end-point score on quality of life/social functioning rating scales).This study was registered with PROSPERO (CRD42020150859).ResultA total of six RCTs including 278 patients assessed ET. The results showed that ET was statistically more efficacious than control groups (standardized mean differences [SMD]: −0.47, 95% confidence interval [CI]: −0.91 to −0.03). In subgroup analysis, exposure therapy was more efficacious for patients with single type of trauma (SMD: −1.04, 95%CI: −1.43 to −0.65), and the intervention using prolonged exposure therapy (PE) (SMD: −1.04, 95%CI: −1.43 to −0.65) was superior. Results for secondary outcomes of efficacy at follow-up (SMD: −0.64, 95%CI: −1.17 to −0.10) and depressive symptoms (SMD: −0.58, 95%CI: −0.93 to −0.22) were similar to the findings for efficacy outcome. No statistically significant effects for acceptability and quality of life/social functioning were found.ConclusionET showed superiority in efficacy at post-treatment/follow-up and depressive symptoms improvement in children and adolescents with PTSD. Patients with single type of trauma may benefit more from ET. Moreover, PE could be a better choice.